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Inicio Medicina Clínica (English Edition) Early diagnosis of systemic amyloidosis by means of a transverse carpal ligament...
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Vol. 148. Issue 5.
Pages 211-214 (March 2017)
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Vol. 148. Issue 5.
Pages 211-214 (March 2017)
Brief report
Early diagnosis of systemic amyloidosis by means of a transverse carpal ligament biopsy carried out during carpal tunnel syndrome surgery
Diagnóstico precoz de amiloidosis sistémica mediante biopsia de ligamento transverso del carpo durante la cirugía del síndrome del túnel carpiano
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Judit Fernández Fuertesa,
Corresponding author
fdezfuertes@gmail.com

Corresponding author.
, Óscar Rodríguez Vicenteb, Sergio Sánchez Herráeza, Luis Rafael Ramos Pascuaa
a Servicio de COT, Hospital Universitario de León, León, Spain
b Servicio de Anestesiología, Hospital Universitario de León, León, Spain
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Tables (3)
Table 1. Clinical results of 11 patients where the FNAB of abdominal fat was amyloid-positive.
Table 2. Incidence of amyloid deposits in the transverse carpal ligament in series of the scientific literature.
Table 3. Clinical cases of systemic amyloidosis whose first symptom was carpal tunnel syndrome.
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Abstract
Introduction and objective

The systematic analysis of a carpal transverse ligament (CTL) sample obtained during routine carpal tunnel syndrome (CTS) surgery may constitute a method of early diagnosis for systemic amyloidosis.

Material and methods

Prospective study carried out on 147 consecutive CTL samples collected from patients intervened for CTS at the University Hospital of León from April 2006 to May 2007. In those cases in which amyloid deposition was observed in the CTL sample, the study was completed with a fine needle aspiration biopsy (FNAB) of the subcutaneous fascia, using the Red Congo stain in both cases. Positive cases were referred to the Internal Medicine and/or Hematology departments, and their evolution was monitored for up to 8 years.

Results

CTL amyloid deposition was observed in 29 patients (19.7%), with a FNAB only being performed in 19 of them (65.5%). The test was positive in 11 cases (57.9%), and 4 patients in this subgroup (3% of the total) developed events attributable to amyloidosis over the following 3 years.

Conclusions

A CTL routine biopsy carried out during CTS surgery may anticipate the systemic amyloidosis diagnosis.

Keywords:
Carpal tunnel syndrome
Amyloidosis
Early diagnosis
Resumen
Introducción y objetivo

Planteamos la posibilidad de que el análisis sistemático de una muestra de ligamento anular anterior del carpo (LAAC) obtenida durante la cirugía rutinaria de síndrome del túnel carpiano (STC) pueda constituir un método de diagnóstico precoz para la amiloidosis sistémica.

Material y métodos

Estudio prospectivo en el que se recogieron las muestras consecutivas de LAAC de 147 pacientes intervenidos por STC en el Hospital Universitario de León entre abril de 2006 y mayo de 2007. En aquellos en los que se observó depósito de amiloide en la muestra de LAAC, se completó el estudio con la realización de punción-aspiración con aguja fina (PAAF) de grasa abdominal subcutánea, utilizando en ambos casos la tinción de Rojo Congo. Los casos positivos fueron derivados a los servicios de Medicina Interna y/o Hematología, observando su evolución durante 8 años.

Resultados

Se observó depósito de amiloide en LAAC en 29 pacientes (19,7%), y pudo realizarse PAAF de grasa abdominal en 19 de ellos (65,5%), resultando positiva en 11 (57,9%); de ellos, 4 pacientes (3% del total) desarrollaron en los 3 años posteriores episodios atribuibles a la amiloidosis.

Conclusiones

La biopsia rutinaria de LAAC durante la cirugía de STC podría adelantar el diagnóstico de la amiloidosis sistémica.

Palabras clave:
Síndrome del túnel del carpo
Amiloidosis
Diagnóstico precoz

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